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Home My WebLink About1000-117.-8-8 T'v6'WVWN OF SOUTHOLD Rental Permit t 0621 Owner Haber A Irry Trt Occupied as Single Family Dwelling Located at 16995 Main Street New Suffolk 117-8-8 Maximum Permitted Occupancy 4 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 4/13/2022 Official This Notice must be posted by the main entrance at all times bode f � Telephone 631)765-1802 Town Hall Annex ;� / � �1�� F ( 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 �� -0959 Southold,NY 11971 �1� ` l BUILDING DEPARTMENT� � TOWN OF SOUTHOL RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Renta! Property Address: Tax Map Number: 1000 SECTION _LQ_-13L0CK Q_n�-LOST— --- SECTION B. OWNER INFORMATION: Property Owner Name: t 6 Property Owner Legal Address: Property Owner Mailing Address: 7 ........�..,.. D ncyTelephone Number(s): Daytime Evening Emerge Property Owner Email Address:M Oul Q,?—Z6� Page 1&S l/tirouii�lq��1 . r � 7 Town Hall Annex ��, Is Telephone(631)765-1802 Ql 631 Fax 765-9502 54375 Main Road ( ) P.O.Box 1 179 Southold,NY 11971-0959 '�fl�pkiG�rS' BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime _ Evening ,„W,_ ,, Emergency__,,,,,,,,_,— Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: ........ Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: `Dinin toov -) 12x I3 )Z--r-Vb i �l�rvo�-►-� I2-"�"� .�. w...�..,.,.. 6�''�IZ,�`1�.._ �'t►-�lo`� l�--ti�., "� c�-� 13x,lg Page 3 of 5 Town Hatt Annex1 Telephone(631)765-1802 54375 Main Road � � � Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOCI'THOLD SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. V/1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I wl .. . ... . _..� certify under penalty of perjury,the following: 1. I am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all Page 4 of 5 Telephone 631)765-1802 Town Hall Annex % /f /rff 1 //7,, Tele P 54375 Main Road765-9502 � � r Fax�631) P.O.Box 117111 Southold,NY 11971-0959 vOv;II�JI'''t . BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days as to any change to the information regarding Authorized Agent, Managing Agent,/or Site Manager. Property Owner's Name: /WII rl er_„ �__ Property Owner's Signature: .f�...,_Sworn to to before me thijl�daY of ��° ��- ' � � A.� Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County l Commission Expires April 14, 2_0�� Page 5 of 5 so fi7k Sf vz#- A)w Ik SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLE;G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING C ] FRAMING /STRAPPING [ ] NAL �&,4t [ ] FIREPLACE CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O T uA W 14 Ki Koo ryn ax 13 [ I�G95 ►-t� � 2►�d `�� I (P� oL � �. Illlllffl � ll l 2x l t7 �3AT14 I ll SMA, r e- su- LIC. 11C1SC Z-",A �2- l2X �� 4X5 Rab N ax Z N G- � p-,v a til �o tit 5"a tc.� �i Gcp Pte- C go,,J Bra.o�lc. � 1�.7 Sc� a ic_ 1 ►s-r a'�-oo�_ E)'ATaft*,►cc 1 1 -7/ D TOWN OF SOUTHOLD PROPERTY RE OWNER STREET =` _ VILLAGE DISTRICT ! SUB. LOT FORMER OWNER N ' E ACREAGE 1 ; S W -- TYPE OF BUILDING f g RES.7 i ! SEAS. VL. FARM COMM. IND. 1 CB. MISC. Est. Mkt. Value LAND IMP, I TOTAL DATE REMARKS 3 - 1 .jL . - € 4-1 t� AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre ; Value Per Acre Value FRONTAGE ON ROAD , i Tillable 1 BULKHEAD Tillable 2 DOCK Tillable. 3 1 � � � —� t T- -_ ------- _ — Woodland I Swampland1-7 ; I Brushland I House Plot ' I , , Tota I 3 ca, Y 3 � a 117.-8-8 11/10 - r; . Bldg. �- ; Fo"ndation Bath Ex�ension Basement Floors Extension Ext. Walls ;'',. interior Finish Extension Fire Place at Porch Roof Type ' Porch R=ms i t Floor Breezeway Patio Rooms 2nd Floor Ge+�ge Driveway Dormer O. B. 1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 34028 Date: 10/x,4,/6 THIS CERTIFIES that the building DWELLING ANDACCESSORY'......„_�.......... ...ro. Location of Property y � � �AIN ST ___.... � NEWUFF SUFFOLK (HOUSE NO ) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 0008 Lot 008 Subdivision Filed Map No_ Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL „w9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 340 .. _ OBER .... 14, 2009 ,288 dated OCTOBER . ...._�,. was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is µ � DWELLING WITH SCREENED PORCH AND ACCESSORY BARN.* issued 1s ONE FAM --.........- The certificate is issued to JOAN B ROBBINS „ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N�_A....._w ELECTRICAL CERTIFICATE NO- PLUMBERS O.PL BERS CERTIFICATION DATED N/A� *PLEASE SEE ATTACHED INSPECTION REPORT. f �horiied Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD LOCATION: §T SUBDIVISION: NAP NO.: LOT (S) NAM OF OWNER (S): JOAN B'ROBRIN§_— ............. OCCUPAbTCY.- ONE,FAMILY DWELLING ADMITTED BY: JOAN riCCONPANIND BY. 11EY AVAIIABLR-. SUFF- CO. TAX NAP NO.: 117--8-8 SOURCE OF REQUEST: m'—(iA!!t..W!tZKHAM DATE: 4 9 ........... DWELLING: TYPE OF CONSTRUCTION: WOO FRA14E # STORIES: 2.0 # FOUNDATION: ST CWZAR: PIT CRAWL SFACRz TOTAL ROOKS- 1ST FLR.: 4 2ND FLR.: 2 3RD FLR.: PlATHROOK(s): 2.0 TOILET ROM(s): 0,0 UTILITY ROOK(S).- YES PORCH TYPE: SCREENED DECK TYPE: PATIO TYPE: BRUEZEsuff FlIMPLACR: GARAGE DONEMC IKYMTER- YES TYPE BEATER: NOT WATER Al:RCXWlTTOKTNG- TYPE HEAT: OIL IUM AIR: �MgK.BOARD.... OTHM- CELLAR ENTRANCE & '5FCOXD-§T9RDEC ........... ............. GARAGE, TYPE OF CUNST— STORAGE, TYPE CONST-- B 21.5' X 24.6' SWINK]= POOL: ..... GUEST, TYPE CONST-: ...... OTHER: BP 19425 FOUNDATION FOR B COZ19 61 ... ........... VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE IAOCATIPN. DES CRIPIION- RE24ARKS: BP9871 ADD COZ13023,_P?1650q_�� ql:)Z16§5g INSPECTED BY: am INSPECTIONX22 05 - GEORGE GILLEN TIM START: END: FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .Z 1.3.0 3 3. . . . . . . . . Date . . . . . . . . . .November - 3.0 . .. 19 .q 4 . » . « .p. THIS CERTIFIES that the building .. . . . . . . . Add.i :ion,. . . . . . . . . rt . .. Location of Property 16995 New, Suffolk A:re. 3rd St: New Suffolk House No. Street Hamlet County Tax Map No. 1000 Section . . .117. . . . . .Block . . . .0 8. . . . . . . . .Lot . . . q 8« . . . . . . . . . . Subdivision . . . . . . . . . . . .�(. « . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . su lY. . . . . . . . .$ , 19 79.pursuant to which Building Permit No. . .9 8 71 Z . . . . dated . . . . . . . . — LY. . . . .?P. . . . . 19 78. ,was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . Addition to Existing One Family Dwelling The certificate is issued to . . . . . . . . . . . . . . . . . . . J " 1 0BBI NS fawn r, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . « « , . . . . . . . . . . ... . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . N45 1.20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1/81 f FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . Z- 1.666?. . . . . . , . Date . . . .February. . 2-2-,. . .19�8.8 . . . . . . . THIS CERTIFIES that the building . . . AL TE RATION „ Location of Property „ 16995 Main Street New Suffolk o- House%Uo. Street Hamlet County Tax Map No. 1000 Section . . .1.17. . . . . .Block . , . .8 . . . M . . . . . .Lot . , $ . , . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . „ . . „ „ . . . . . . . .Filed Map No, . , . . , . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept . ' 198 1 7 pursuant to which Building Permit No. , , 6 5 OZ µ0 . . . . . . . . . . µ . October 7 , 1987 dated . . . , . . . . I . . . . . . . , . , < „ , . , . . . . was issued, and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is . . . . . . . . . ALTERATION TO SECOND FLOOR BATHROOM AS APPLIED FOR The certificate is issued to . . , , JOAN B : RO B B I N S towner, , A of the aforesaid building. Suffolk County Department of Health Approval . , , , „ N/A . . UNDERWRITERS CERTIFICATE NO. . . . . „ . , . . . , . . . N 0 0 l 9 2 5 . . . . . . . , . . PLUMBERS CERTIFICATION DATED: February 22 , 1988 — Mattituck Plumbing & _,..w......_...,.._..we..._._ ...... ...............w„....� Heating Corp. _._.... . „ . � . . . . . . . . . . . . . . . . . . . . Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219561 Date DEC. 5 1990 THIS CERTIFIES that the building FOUNDATION Location of Property 116995 MAIN ST. & 770 THIRD ST. NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 08 Lot 05 Subdivision Filed Map No. Lot No.� conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 26 1990 ______pursuant to which Building Permit No. 194252 dated SEPT. 27 1990 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is FOUNDATION UNDER AN EXISTING BARN. The certificate is issued to JOAN ROBBINS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N161502 NOVEMBER 19 1990 PLUMBERS CERTIFICATION DATED, VA Bu lding Inspector Rev. 1/81 �� i �� u i d; �� lI, "��`' � r�, �r`,�F ��r�� I�� s , ,' i o ro / ,� I �� ',1 ��, Irl �� '�� f�l/ �i 'U � � � �� i �I it SMOKE & CARBON MONOXIDE ALARM • f/ ��f IIIA i4i�r.,